Antibiotic Associated Diarrhea with Special Reference to Clostridium difficile

Introduction: Antibiotic associated diarrhea (AAD) is a common side effect of treatment with antibiotics. Depending on the antibiotic used, up to 25% of patients experience such unpleasant bowel conditions. The normal flora is replaced by pathogenic organisms like Candida species, Clostridium difficile etc which play an important role in the causation of AAD. Almost all the antibiotics have been associated with diarrhea. C. difficile is known to occur as an outbreak in health care settings in cases of AAD. However reports from India are in-frequent. Aims: Our present study was undertaken to assess the role of different pathogen in causation of AAD and to evaluate the role of various antimicrobials in causation of AAD.

Study Design: Prospective observational study.

Place and Duration of Study: Department of Microbiology, B.J. Government Medical College and Sassoon General Hospital, Pune from January 2014 to December 2015.

Materials and Methods: Stool samples of 70 patients developing AAD were included in the study. Individuals from all age groups were included in the study. Majority of the patients were from the age group 31 to 40 years with female preponderance Outdoor as well as Indoor patients from all faculties like medicine, surgery, obstetrics and gynecology and pediatrics were included in the present study. Samples were subjected to aerobic, anaerobic and fungal culture. C. difficile toxin was detected in stool by ELISA. PCR was also performed to look for the presence of C. difficile DNA in stool sample.

Results: Ceftriaxone (55.7%) was the commonest antibiotic causing AAD followed by amoxicillin (44.3%) and amoxicillin plus clavulanic acid (41.4%). Candida species was the major pathogen isolated from 58.6% of patients. Clostridium difficile associated diarrhea either by culture, PCR or toxin detection was seen in 18.6% of patients. Aerobic pathogens were detected in 18.6% cases of AAD. Klebsiella pneumonia (8.6%) was the commonest. No pathogens were detected in 4.3% cases.

Conclusion: Candida species (58.6%) is the major pathogen in AAD in our tertiary care center. However Clostridium difficile (18.6%) seems to be an emerging pathogen in our health care setting. It has been reported from the developed countries in epidemic proportions but seems to be just gaining foothold in India. Apart from stoppage of antibiotics, it is important to identify the pathogen in AAD so that appropriate management may be instituted.